前列腺癌风险预测：前列腺体积和直肠指检在 ERSPC 风险计算器中的作用。
Prediction of prostate cancer risk: the role of prostate volume and digital rectal examination in the ERSPC risk calculators.
机构信息
Erasmus University Medical Centre, Department of Urology, Rotterdam, The Netherlands.
出版信息
Eur Urol. 2012 Mar;61(3):577-83. doi: 10.1016/j.eururo.2011.11.012. Epub 2011 Nov 15.
BACKGROUND
The European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculators (RCs) are validated tools for prostate cancer (PCa) risk assessment and include prostate volume (PV) data from transrectal ultrasound (TRUS).
OBJECTIVE
Develop and validate an RC based on digital rectal examination (DRE) that circumvents the need for TRUS but still includes information on PV.
DESIGN, SETTING, AND PARTICIPANTS: For development of the DRE-based RC, we studied the original ERSPC Rotterdam RC population including 3624 men (885 PCa cases) and 2896 men (547 PCa cases) detected at first and repeat screening 4 yr later, respectively. A validation cohort consisted of 322 men, screened in 2010-2011 as participants in ERSPC Rotterdam.
MEASUREMENTS
Data on TRUS-assessed PV in the development cohorts were re-coded into three categories (25, 40, and 60 cm3) to assess the loss of information by categorization of volume information. New RCs including PSA, DRE, and PV categories (DRE-based RC) were developed for men with and without a previous negative biopsy to predict overall and clinically significant PCa (high-grade [HG] PCa) defined as T stage>T2b and/or Gleason score≥7. Predictive accuracy was quantified by the area under the receiver operating curve. We compared performance with the Prostate Cancer Prevention Trial (PCPT) RC in the validation study.
RESULTS AND LIMITATIONS
Areas under the curve (AUC) of prostate-specific antigen (PSA) alone, PSA and DRE, the DRE-based RC, and the original ERSPC RC to predict PCa at initial biopsy were 0.69, 0.73, 0.77, and 0.79, respectively. The corresponding AUCs for predicting HG PCa were higher (0.74, 0.82, 0.85, and 0.86). Similar results were seen in men previously biopsied and in the validation cohort. The DRE-based RC outperformed the PCPT RC (AUC 0.69 vs 0.59; p=0.0001) and a model based on PSA and DRE only (AUC 0.69 vs 0.63; p=0.0075) in the relatively small validation cohort. Further validation is required.
CONCLUSIONS
An RC should contain volume estimates based either on TRUS or DRE. Replacing TRUS measurements by DRE estimates may enhance implementation in the daily practice of urologists and general practitioners.
背景
欧洲前列腺癌筛查随机研究（ERSPC）风险计算器（RC）是用于前列腺癌（PCa）风险评估的经过验证的工具，包括经直肠超声（TRUS）的前列腺体积（PV）数据。
目的
开发和验证一种基于直肠指检（DRE）的 RC，该 RC 无需 TRUS 即可进行，但仍包括 PV 信息。
设计、地点和参与者：为了开发基于 DRE 的 RC，我们研究了最初的 ERSPC 鹿特丹 RC 人群，其中包括 3624 名男性（885 例 PCa 病例）和 2896 名男性（547 例 PCa 病例），分别在首次和 4 年后的重复筛查中发现。验证队列由 322 名男性组成，他们于 2010-2011 年作为 ERSPC 鹿特丹的参与者进行筛查。
测量
开发队列中 TRUS 评估的 PV 数据被重新编码为三个类别（25、40 和 60 cm3），以评估通过体积信息分类丢失的信息。为以前未进行过阴性活检的男性和进行过阴性活检的男性开发了新的 RC，包括 PSA、DRE 和 PV 类别（基于 DRE 的 RC），以预测总体和临床显著的 PCa（高级别[HG] PCa）定义为 T 期>T2b 和/或 Gleason 评分≥7。通过接受者操作特征曲线下的面积来量化预测准确性。我们在验证研究中比较了与前列腺癌预防试验（PCPT）RC 的性能。
结果和局限性
单独使用前列腺特异性抗原（PSA）、PSA 和 DRE、基于 DRE 的 RC 和原始 ERSPC RC 预测初始活检中 PCa 的曲线下面积（AUC）分别为 0.69、0.73、0.77 和 0.79。预测 HG PCa 的相应 AUC 更高（0.74、0.82、0.85 和 0.86）。在以前进行过活检的男性和验证队列中也观察到了类似的结果。在相对较小的验证队列中，基于 DRE 的 RC 优于 PCPT RC（AUC 0.69 与 0.59；p=0.0001）和仅基于 PSA 和 DRE 的模型（AUC 0.69 与 0.63；p=0.0075）。需要进一步验证。
结论
RC 应包含基于 TRUS 或 DRE 的体积估计值。用 DRE 估计值代替 TRUS 测量值可能会增强泌尿科医生和全科医生在日常实践中的实施。
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